Majority of LAHNC patients use life-altering strategies to cope with costs of treatment

SCOTTSDALE, Ariz., February 18, 2016--The majority of patients with locally advanced head and neck cancers (LAHNC) rely on cost-coping strategies that alter their lifestyle in order to manage the financial burden of their care, according to research presented at the 2016 Multidisciplinary Head and Neck Cancer Symposium. Researchers also identified perceived social isolation, or a lack of social support coupled with increased loneliness, as a risk factor for sub-optimal medication adherence and health care utilization during treatment for LAHNC.

Treatment for locally advanced head and neck cancers -- diseases marked by high morbidity and high treatment costs -- is very intense, often combining surgery, radiation therapy and chemotherapy. Moreover, treatment often causes social side effects, such as an increased financial toxicity or financial burden, in addition to physical side effects. This study examined factors associated with these social side effects by following patients diagnosed with head and neck cancer over six months to assess how they coped with the cost of their cancer treatment as well as whether perceived social isolation, or the lack of social support, was a barrier to their care.

This prospective longitudinal study collected six monthly lifestyle surveys from 73 patients with treatment-naive LAHNC who were diagnosed at a single, high volume institution between May 2013 and November 2014. The survey assessed the use of several lifestyle-altering financial coping strategies, as well as out-of-pocket costs, loss of productivity, compliance with their medication regimen, and health care utilization (specifically, inpatient length of hospital stays and number of missed appointments). Researchers also measured patients' demographics, health insurance status, wealth, household income and type of tumor. Perceived social isolation was evaluated prior to treatment for each patient.

Most patients in the study were male (78 percent), Caucasian (74 percent) and covered by private health insurance (54.8 percent). Multivariable regression modeling was used to assess the influence of patient characteristics on the use of cost-coping strategies and perceived social isolation.

More than two thirds (69 percent) of the LAHNC patients reported relying on one or more lifestyle-altering cost-coping strategy while managing their cancer. The most common strategy was spending savings (62 percent), followed by borrowing money (42 percent), selling possessions (25 percent) and having family members work more hours (23 percent).

Socioeconomic factors were associated with reliance on cost-coping strategies. Patients with Medicaid used more financial coping strategies compared to patients with private insurance (Odds Ratio (OR), 42.3; p = 0.005). In addition, increased out-of-pocket costs and decreased wealth were independently associated with the use of cost-coping strategies (p < 0.01).

"Physical side effects are not the only ones our patients endure," said Sunny Kung, a second-year medical student at the University of Chicago Pritzker School of Medicine and lead author on the study. "Our findings indicate that the majority of our patients have adopted or will adopt strategies to cope with the financial side effects of their care."

The study also examined prevalence of perceived social isolation among LAHNC patients and its association with socioeconomic factors and health care utilization. Researchers identified perceived isolation in seven of the 73 patients (9.5 percent) prior to treatment. Patients who reported high perceived social isolation were more likely to be unemployed (p = 0.02) and divorced or widowed (p < 0.001).

High perceived social isolation prior to treatment predicted lower health care utilization in the following six months. Compared to LAHNC patients with adequate social support, those in the perceived social isolation cohort reported more days missing prescribed medication (21.4 vs. 5.45 days over six months, p = 0.02), more missed appointments (7 vs. 3 appointments, p = 0.007), and longer inpatient hospital stays (32.7 vs. 27.6 days over six months, p = 0.17).

"Many of the patients we treat for advanced head and neck cancers may need support beyond their medical care," said Ms. Kung. "Social interventions can be introduced for patients who feel isolated in order to minimize financial burden while maximizing effective health care utilization. For example, providers can work with patient navigators to improve adherence to medical care among vulnerable populations."

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The abstract, "Cost-coping Strategies and Perceived Social Isolation in Locally Advanced Head and Neck Cancer," will be presented in detail as a poster presentation at the 2016 Multidisciplinary Head and Neck Cancer Symposium in Scottsdale, Arizona. To speak with Ms. Kung, contact the ASTRO media relations team at 480-905-7935 (February 18-19 only), 703-286-1600 or press@astro.org.

The 2016 Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Society for Radiation Oncology (ASTRO), the American Society of Clinical Oncology (ASCO) and the American Head & Neck Society (AHNS). The two-and-a-half day meeting includes interactive educational sessions focused on topics such as novel multidisciplinary therapies, directed therapy, treatment guidelines, prevention, surveillance and supportive care, as well as 13 oral abstract presentations of the current science of relevance to the head and neck cancer community. A total of 262 abstracts will be presented, including 249 posters. Keynote speakers include Tanguy Seiwert, MD, of the University of Chicago, to present "Immunotherapy for Head and Neck Cancer;" Robert I. Haddad, MD, of Brigham and Women's Hospital, to present "Personalized Treatment for Head and Neck Cancer -- The Time is Now;" Quynh-Thu Le, MD, FASTRO, of the Stanford School of Medicine, to present "Precision Therapy in Head and Neck Cancer -- From Technology to Biomarker-based Risk Stratification;" and Neil Hayes, MD, MPH, of the UNC School of Medicine, to present "Genome Atlas and Sequencing Data: How We Use This Going Forward."

ABOUT ASTRO

ASTRO is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology * Biology * Physics, Practical Radiation Oncology and Advances in Radiation Oncology; developed and maintains an extensive patient website, RT Answers; and created the Radiation Oncology Institute, a nonprofit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO, visit http://www.astro.org.

ABOUT ASCO

Founded in 1964, the American Society of Clinical Oncology (ASCO) is the world's leading professional organization representing physicians who care for people with cancer. With nearly 40,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation, which funds ground-breaking research and programs that make a tangible difference in the lives of people with cancer. For ASCO information and resources, visit http://www.asco.org. Patient-oriented cancer information is available at http://www.cancer.net.

ABOUT AHNS

The American Head & Neck Society (AHNS) is the single largest organization in North America for the advancement of research and education in head and neck oncology. The mission of the American Head and Neck Society is: to promote and advance the knowledge of prevention, diagnosis, treatment, and rehabilitation of neoplasms and other diseases of the head and neck; to promote and advance research in diseases of the head and neck, and; to promote and advance the highest professional and ethical standards. For more information, visit http://www.ahns.info.

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